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§ 10-16-144. Health care services provided by pharmacists

CO Rev Stat § 10-16-144 (2018) (N/A)
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(1) Any health benefit plan, except supplemental policies covering a specified disease or other limited benefit, that provides hospital, surgical, or medical expense insurance may provide coverage for health care services under a specific treatment protocol provided by a pharmacist if:

(a) The pharmacist meets the requirements in part 6 of article 42.5 of title 12, C.R.S.;

(b) The health benefit plan provides coverage for the same service provided by a licensed physician or an advanced practice nurse;

(c) The pharmacist is included in the health benefit plan's network of participating providers; and

(d) A reimbursement rate has been successfully negotiated in good faith between the pharmacist and the health plan.

(2) (a) A health benefit plan described in subsection (1) of this section shall provide coverage for health care services provided by a pharmacist within a health professional shortage area, as defined in 42 U.S.C. sec. 254e, if the conditions specified in subsection (1) of this section are met.

(b) This subsection (2) does not require a carrier to contract with a pharmacy or pharmacist willing to abide by the terms and conditions for participation established by the health benefit plan or carrier.

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